Some days I’d finish at the office having done nothing that looked hard. No surgical extractions, no full-mouth rehab, no fires. And I’d still drive home wrung out, snapping at my boys over nothing, too fried to decide what to make for dinner. For years I assumed that was just dentistry being draining. It took me a while to understand what was actually happening: I wasn’t tired from the dentistry. I was tired from the deciding.
What Decision Fatigue Actually Is
There’s a name for it: decision fatigue. The idea is simple. Every choice you make pulls from the same mental tank, and as the tank drains, your decisions get worse. You stop weighing things carefully and start reaching for whatever’s easiest. The status quo. The default. The “let’s just do it the way we always do.”
The clinical research on this is sobering. Studies of physicians have found that doctors prescribe unnecessary antibiotics at higher rates for every hour later in the day. Opioid prescribing climbs later in the workday, and recommendations for cancer screening drop off as a clinic session wears on. Patients seen at 4 p.m. simply get offered less than identical patients seen at 9 a.m. A large analysis of primary care prescribing found the same shape: over the course of a workday, doctors issue more of the easy, conservative prescriptions and fewer of the effortful, beneficial ones. Same doctor. Same training. Different time on the clock.
To be fair, the science isn’t fully settled. A large, careful 2025 study of healthcare workers making thousands of judgments found no credible evidence for decision fatigue as a clean, measurable effect, and researchers have rightly pushed back on some of the splashier early claims. So this isn’t iron clad law. But here’s what I know in my bones: the majority of clinicians take no real breaks during long sessions, and more than a quarter work full days without a proper one. I surely do. We don’t do lunch in our office. We work straight through 8 a.m. to 4:30 p.m., a holdover from COVID that we just keep because we have too many patients. Whatever you call the mechanism, the cognitive load is real, and so is what it does to us.
Where This Hits Dentistry Hardest
Look at where dentistry has landed with these habits. The ADA’s 2024 trend report found 82% of dentists reporting major stress and career burnout. A separate 2024 study put burnout symptoms at around 44%, with emotional exhaustion most common, and dentists in solo or small group practices at the highest risk of all.
That last part isn’t a coincidence. The fewer people you have to share decisions with, the heavier the load lands on you. And it matters clinically, not just personally. Dentists who reported making a major error were significantly more distressed than those who hadn’t. Tired judgment and mistakes travel together.
Why Dentists Carry a Heavier Load
Here’s why our profession is uniquely exposed. A dentist isn’t just making clinical calls all day: watch this, restore that, refer or treat. We’re also the business. Between patients you’re deciding the schedule, the staffing gap, the weird vendor charge on the statement, how to word the perio conversation, whether to chase the no-show.
Clinical micro-decisions stack on operational ones, hundreds a day, and most of them aren’t even hard. They’re just uncounted. And the cruelest part is that the small, recurring ones get re-decided every single day, from scratch, as if you’ve never faced them before.
Systemization Is the Fix
That’s the real enemy, and it’s also the fixable one. You cannot, and shouldn’t, make fewer decisions about your patients. But you can stop re-deciding the same 200 operational things over and over. That’s what systemization actually is: deciding something once, writing it down, and turning it into a default so it never taxes you again.
Your hygiene reappointment script. Your SRP case presentation. Your end of day close. Your hiring rubric. Every protocol you write is one recurring decision lifted permanently off your plate. We’ve written before about why dental practice fundamentals never change, and documented systems sit right at the center of that list. So does the person running them: your practice rises or falls with your office manager, because a strong operator is the one who keeps those defaults from quietly slipping.
This is why practices that run on documented systems feel calmer. Not because they work less, but because their owners aren’t bleeding willpower on settled questions. They spend their judgment where it counts: on the tough case in chair three, and on being a present human being when they walk in their front door at night.
Your One Move This Week
Notice the decisions you don’t count. Catch the one you’ve quietly made fifty times already. Then write it down once, so you never have to make it tired again.
If you want to copy any of our systems at DSN, check out our ordering, hygiene, and office manager manuals.
Be well and do well,
Addison Killeen
